Actually, it started in the U.S. with public health nurses and insurance companies. Doctors actually went out and got that stopped.

That they are behind it now, due to the fact that they collect payment for administering it when nurses used to go door to door and provide the service for free, doesn’t tell me anything that makes me want to give them credit.

The point about the most necessary medicines is that those are where the biggest benefits are seen. Not every drug or every treatment will make a big impact in your overall health. For any treatments that do make a large impact on your health, I assure you that even people who had to pay received the necessary treatments.

Big effects in healthcare can be seen for those who are sick… it is much harder to see effects of medicine when you take a sample from the general population, thus you should need an even bigger sample if you want to see a benefit.

Unfortunately, as medicines become better and better, it becomes harder and harder to improve upon the standard of care. This is one of the reasons why clinical trials require so many patients to see the positive benefits of a new drug. In addition, even when the population in your study is sick, it can still be difficult to see the benefits when looking at events with low incidence rates…. and this is even when your population is sick. Can you imagine how woefully underpowered you must be when looking at a group of healthy people.

By the way, for those of you who are interested, the study looked at 2750 families, the mean age was ONLY 33, the youngest person was 14, and the maximum age at time of enrollment was 61.

Why is every medicine supposed to have a big impact? Won’t some have a larger effect? For the meds that are truly important, don’t you think that most groups received those, and the less important, those that don’t have as large of an impact, were probably what were used more in the free group.

Though there may not have been noticeable overall health benefits from going to see the doctor more, as was done in the treatment group, who is to say that they didn’t recover from illness faster? For most common ailments, our immune system can fight them off slowly and your health overall won’t be affected much by not going to the doctor. However, how much of a benefit is there to taking a drug that speeds up the recovery process, though it may not be a benefit to your overall health. Factors such as this don’t show up in the Rand study results.

Also, let’s say I’m in the free group, is there a benefit to going to the doctor at some of the first signs of getting sick? Even if I find out that if I have a virus that can’t be treated by antibiotics, should I not have gone? Should I have used less free health services because my immune system would have most likely been able to handle the ailment? Going to the doctor more often does not necessarily mean that they received more meds… a lot of the times were probably because they were being cautious and because they could for free. When you have to pay, people aren’t usually willing to seek care until they get really sick and know that they need to be seen. However, even at this point if they do have something treatable, their overall health is not going to be affected by having waited to see if their immune system could handle it.

The RAND study was surprising to many people, including me. All health care is supposed to help; the study found that a lot of it did not clearly help. I think there is something to be learned from that.

“Whose fault is that?” I’m trying to describe the situation. Since you ask I don’t blame either the doctor or the patient. I blame human nature.

You’re right, to say the special thing about insulin is that patients “adminster it themselves” is confusing. As you say most drugs are self-administered. I should have said that insulin is special in two ways: it replaces something missing from the body; and the administration (to be effective) has to be remarkably careful and intricate. It is true that in the right hands, insulin is a major medical success story. Those “right hands” however are few. Perhaps they will become more common in the future. Self-experimentation played a very big role in showing how insulin could be used most effectively. Something else that sets insulin apart from other treatments.

“Diabetics have been helped by synthetic insulin, indeed. But they administer it themselves. It’s a special case, between medicine and prevention. And in spite of this help, diabetes is a major cause of death and disability. No doubt because of obesity, which doctors have done nothing to help with.”

You are right. Doctors do not yet have a magical cure for diabetes that enables patients to not have to take care of themselves. But whose fault is that really? The doctor’s fault, or the patient’s fault?

If a doctor tells me to take an antibiotic, and then I self-administer it, does this also fall in between medicine and treatment?

As I mentioned earlier, insulin is a special case, halfway between prevention and treatment.

After visiting Bangladesh, I would have to disagree with you. There are plenty of people walking around with what seemed to be treatable problems. They probably would value any doctoring…even if it doesn’t hold up to your standards.

I would also argue with your definitions. All of vacines and most public health stuff is most strongly driven by doctors. They should get credit for that.

Lastly, everyone’s prize evidence; an annecdote. (hey wait doesn’t this stinking comments section have a spell checker?)

My wife had a mysterious infection that distroyed her vistibular nerves. She lost much of her sense of balance. There was nothing that could be done. But after much much testing and expense, they did figure out what had happened.

The neurologist had no cure, but his explanation of what had happened and his discussion about the sort of accomadations and changes she needed to make in her life style allowed her to get on with her life. Up until then she was floundering and unable to work or even to function very much.

So the point is, what would a study of effectiveness make of this. In one way we spent a lot of money on doctors and in the end they could do nothing. On the other hand, the information about what had happened and how to go forward kind of saved her life.